口腔颌面部骨折102例临床分析

目的：总结2000年以来口腔颌面部骨折病例诊治的临床体会。方法：对102例口腔颌面部骨折病例进行回顾性分析,包括年龄、性别、致伤原因、损伤部位、损伤类型、治疗方法等。结果：102例中下颌骨骨折72例（70.5%）,上颌骨骨折8例（8%）,颧骨骨折22例（21.5%）。交通事故伤69例（68%）,其中机动车致伤51例（50%）,非机动车致伤18例（18%）;他伤16例（15%）;意外伤17例（17%）。15例单纯采用非手术牵引钛钉颌间牵引治疗,74例采用手术切开复位钛板钛钉内固定治疗,13例为钛钉颌间牵引下切开复位内固定治疗。结论：颌面部骨折多因交通事故所致,且多发于下颌骨。钛钉颌面牵引内固定术是一种良好的治疗颌骨骨折的方法。     

口腔颌面部创伤

实验性骨质疏松症对下颌骨骨折愈合的影响；颧骨复合体骨折临床治疗探讨；526例下颌骨髁状突骨折临床病例回顾性研究；上颌骨骨折合并泪道损伤的早期处理及意义；重症颌面部损伤患者的首（急）诊护理；下颌骨髁突骨折治疗的Meta分析；颌面创伤3958例临床回顾；69例老年患者颌面部骨折的临床分析；颌骨骨折合并颅脑损伤的处理；颌面部外伤患者早期的个性及心理调查。[编者按]     

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目的回顾性分析颌面部骨折患者的临床资料,对患者性别、年龄、致伤原因、合并损伤及治疗方法进行临床流行病学总结。方法对中国医科大学口腔医学院2004年9月至2007年12月收治的580例颌面部骨折患者的病例资料进行统计和分析。结果580例颌面部骨折患者男女比例为3.75:1。>20～40岁为发生的高峰年龄段,占55.0%。骨折以5、8、9月份多发。交通事故在致伤原因中居首位,占57.24%。颌面部骨折类型以下颌骨骨折发生率最高,占61.72%。伴有神经损伤者219例,其中以眶下神经损伤发生率最高,占47.94%。合并损伤以四肢损伤最为多见,占合并损伤患者的37.86%,颅脑损伤居第2位,占26.70%。颌面骨折治疗以坚固内固定为主要方式,占83.60%。结论颌面部骨折发病率逐年上升,交通事故为主要致伤原因,发病人群以青壮年为主,坚固内固定为主要治疗方式。     

面中部骨折的治疗进展

面中部骨折约占颌面部骨折的40%以上,由于邻近颅底,常伴发颅脑损伤。在颌面部的组织结构中,面中部骨骼的解剖结构最为复杂。因面中部与眼眶相邻,颧骨复合体骨折、上颌骨LeFortⅡ型和Ⅲ型骨折、鼻眶筛骨骨折等面中部骨折时常伴发眶底骨折,从而可造成严重的眼功能障碍,包括复视、眼球内陷、眼球运动障碍、视力下降等。     

颌面部创伤356例的临床分析

目的:回顾分析356例颌面部创伤患者的临床资料,探讨口腔颌面部创伤好发人群、受伤原因、骨折部位及合并症等临床流行病学特点。方法:对356例口腔颌面部创伤患者的临床资料进行流行病学调查分析。结果:男女患者比例为3.75∶1;21～40岁组为高发年龄段(58.5%);交通事故为最常见受伤原因(52.5%);下颌骨骨折发生率最高(68.5%),其次是颧骨颧弓骨折(15.8%);颅脑损伤是最常见的合并伤。结论:交通事故伤呈上升趋势,颅脑损伤为最严重的并发症,危及生命,应及时救治。     

呼和浩特地区颌面部骨折的临床流行病学研究

目的通过大量临床病例资料的流行病学回顾性研究,明确呼和浩特地区颌面部骨折患者的流行病学特点,为呼和浩特地区颌面部骨折的防治提供流行病学依据。方法收集呼和浩特地区医院2002年7月～2007年6月五年间颌面部骨折住院患者的病例资料,对每位患者的年龄、性别、居住地区、损伤原因、骨折部位、合并损伤及治疗方法等内容进行统计学分析。结果共收集病例516例,男性454例,女性62例,男：女为7.32：1,好发年龄为21～40岁。交通事故是主要损伤原因,占64.66%,其中摩托车致伤158例,占49.07%;汽车致伤152例,占47.20%;非机动车辆致伤12例,占3.73%。经统计分析,郊区的交通事故高于市区,摩托车肇事是造成郊区交通事故的主要原因。下颌骨是最常见的骨折部位。四肢、颅脑是最常见的合并损伤。结论在救治颌面创伤的同时,应观察患者的生命体征,注意颅脑、四肢等合并伤的救治。     

885例颌面部损伤回顾分析

目的:回顾分析深圳特区885例颌面部损伤的临床流行病学特点。方法:对深圳市龙岗中心医院口腔科1998年1月-2002年6月间收治的885名颌面部损伤患者的病历资料进行临床流行病学回顾性研究。结果:颌面损伤患者人数占本科住院总人数的76.6％,男女比例为3.5:1,21-30岁为发病高峰年龄段,机动车事故在致伤原因中居首位,占52.09％。颌面部损伤以单纯软组织损伤最为多见,占68.93％;颌面部骨折以下颌骨骨折最多见,占面部骨折总数的17.85％,其次是颧骨和上颌骨骨折。颅脑损伤和四肢损伤是颌面损伤的常见合并伤。结论:男性青年为颌面损伤高发人群,机动车是主要致伤原因,软组织伤最多见,下颌骨为骨折多发部位,颅脑伤为常见合并伤。     

颅脑损伤合并口腔颌面部损伤及漏诊分析

口腔颌面部居头颅的下三分之二 ,颅脑损伤时亦常波及口腔颌面部。我院 1 996～ 1 999年收治的各类颅脑损伤 1 68例 ,其中合并口腔颌面部损伤 56例占三分之一 ,初诊漏诊 6例 (约 1 0 % )。临床资料表 1　口腔颌部损伤的性别年龄分布性别 10岁以下 10～ 2 0 2 1～3031～5 0(岁 )合计男 3 82 7 7 45女 2 6 3 11合计 3 10 33 10 5 6表 2　口腔颌面部损伤的诊断和原因诊断例数原因例数软组织挫裂伤 40交通事故 30上下颌骨、颧骨骨折 4劳动致伤 11上颌骨骨折 3打架斗殴 10下颌骨骨折 4跌　伤 3牙折及牙龈撕裂伤 3爆炸伤 2爆炸伤合并下颌骨骨折 2讨…     

口腔颌面部堕落伤的致伤机理与治疗

随着经济的发展,交通事故伤和工伤的发生率相对增多,在交通事故伤和堕落工伤伤员中都有着速度突变的特点和相类似的致伤机理。本文在117例口腔颌面部骨折伤员中对12例堕落伤员的致伤机理及治疗情况作一探讨。 临床资料 本组12例堕落伤中,男性8例,女性4例。患者年龄最小20岁,最大45岁,平均28.1岁,多发于青年时期。伤员堕落时的高度在3米以上,最高达9米,均堕落在泥质地面上。伤员的伤情;12例伤员中,5例为面中部多发性骨折(即上颌骨、颧骨、颧弓、眶的侧缘和鼻骨骨折,其中2例合并有下颌骨骨折),7例为下颌骨粉碎性骨折。合并有四肢骨骨折者5例,其中股骨骨折3例,胫腓骨骨折1例,髋骨和踝部骨折等1例。合并有颅脑损伤者11例,其中轻型者7例,中型2例,重型2例;1例因颅内出血行手术治疗,1例因脑损伤重行气管切开术。本组病例均在颅脑伤情稳定后,行切开复位颌骨骨     

眼眶骨折继发眼球内陷手术矫治与疗效相关因素的探讨

眼眶骨折是常见的颅颌面损伤类型之一,可单独或与颅颌面其他骨折同时发生.眼眶骨折可分为单纯性骨折(pure orbital fracture)和非单纯性骨折(impure orbital fracture)[1],前者是眶缘完整,仅眶壁发生骨折;后者为眶缘、眶壁联合骨折,多为颧骨复合体、鼻-眶-筛以及额骨骨折合并的眼眶骨折.Stoll[2]总结264例眼眶骨折,其中单纯性眼眶骨折占21%,非单纯性眼眶骨折比例为79%.Manolidis 等[3]总结96例111侧非单纯性眼眶骨折,其中50%合并颧骨复合体骨折,32%合并鼻-眶-筛骨折,28%合并额骨骨折.单纯性眼眶骨折主要为拳击伤或摔伤,而大多数非单纯性眼眶骨折为交通事故伤[3-4].Seider等[4]总结非单纯性眼眶骨折眼球内陷的发生率是单纯性眼眶骨折的5倍.     

2461例颌面部骨折患者临床分析

目的 对2461例颌面部骨折病例进行临床回顾研究.方法 对广州中医药大学附属佛山中医院2003至2009年间因颌面部创伤住院的2461例骨折患者进行回顾分析,明确患者性别、年龄、损伤原因、职业、地域分布、血型、骨折部位、多处合并伤、损伤程度、首诊收入科室、治疗效果.结果 2461例颌面部骨折病例中,男女比例为4.28∶1;20～40岁为发病的高峰年龄(1424/2461,57.86%);道路交通伤938例(40.98%),在致伤原因中居首位;第三产业900例(78.53%),尤其从事交通运输业人员是最易骨折群体;颧骨复合体、鼻骨、下颌骨骨折分别占22.08%(955处/4325处)、20.67%(894处/4325处)和16.35%(707处/4325处),以上是颌面部骨折最好发部位;常合并颅骨、颅脑损伤及软组织挫裂伤,分别为21.74%、38.36%和48.84%.简明损伤评分法(abbrebiated injury scale,AIS)评分85.98%(2116例/2461例)患者小于2分;38.16%(939例/2461例)的患者首诊收入骨科.结论 颌面部骨折发病率逐年上升,交通事故为主要致伤原因,损伤程度较轻,常合并骨科损伤,男性较女性多见,发病人群以青壮年为主.

Abstract：

Objective To review the 2461 cases of maxillofacial fractures. Methods From 2003 to 2009, 2461 maxillofacial fracture cases were treated in Foshan Hospital of Traditional Chinese Medicine,Guangzhou University of Traditional Chinese Medicine. Data regarding sex, age, cause of injury,occupation,geographic distribution, blood type, fracture site, multiple associated injuries, injury severity, the patient's first admitted department, treatment results were reviewed. Results The male and female ratio was was road traffic accident(938 cases,40.98% ). People in tertiary industry(900 cases,78.53% ) were most vulnerable to injuries. The zygomatic complex (22.08% ), nasal bone (20.67% ) and mandible ( 16.35% )were the most frequent fracture sites, which were often associated with skull ( 21.74% ), brain ( 38.36% )and soft tissue contusion injury (48.84% ). 85.98% (2116/2461 cases), of patients' AIS score was less than 2. Orthopaedics (939/2461 cases, 38.16% ) was the first admitted department. Conclusions The traffic accidents are the main cause of the maxillofacial fractures. Most injuries are found in the young and middle-aged people.     

A ten year analysis of the traumatic maxillofacial and brain injury patient in Amsterdam: Complications and treatment

Maxillofacial trauma is often associated with injuries to the cranium, especially in high-energy trauma. The management of such cases can be challenging and requires close cooperation between oral and maxillofacial surgery and neurosurgical teams. There are few reports in the current literature describing the complications that develop in patients with maxillofacial trauma and traumatic brain injury (TBI). Complications can be categorized as early or late and/or minor and major. The exact definition of complications and their categorization remains a matter of current debate. We present a 10 year retrospective study of complications and their subsequent management in patients receiving maxillofacial and neurosurgical treatment for maxillofacial trauma associated with TBI. The study population consisted of 47 people, excluded from a maxillofacial trauma population of 579 patients. The severity of the trauma was scored as mild, moderate or severe, using the Glasgow Coma Scale at presentation of the Emergency Department. In total 36 patients (76.6%) developed complications. Patients involved in road traffic collision were most likely to develop complications (92.3%). This was followed by falls (66.7%) as mechanism of the injury. Patients aged 60–69 years experienced the highest complication rate (5), followed by patients aged 20–29 years (4.1) and 30–39 years (3.5). The majority of complications were infection and inflammation (36.4%), followed by neurological deficit (24.0%), physiological dysregulation (11.6%) and facial bone deformity (8.3%). Patients who developed no complications, most often presented with mild TBI (72.7%).The most common treatment modality employed to manage complications was pharmacological, followed by antibiotic treatment, conservative treatment and decompression therapy. The mean hospital stay after the trauma for the patients with complications was 28 days. Thirteen patients (36.1%) were transferred to a rehabilitation centre, a nursing home, or a home for the elderly. Nine patients (25%) completely recovered from their complications and 4 patients (11.1%) died after the trauma. This report provides useful data concerning the rate and type of complications that occur, and the multidisciplinary treatment that is required in traumatic maxillofacial and brain injury patients.     

Fractures of the mandible in the aging population

Maxillofacial trauma in elderly patients represents a significant social concern, as it uses one‐third of all medical resources allocated to trauma care. Studies have shown the incidence of maxillofacial trauma in the elderly population has been increasing over the past 30 years. A common injury in patients who present with maxillofacial trauma is fracture of the mandible. The etiology, demographics, and management of elderly patients with mandibular fractures differ from younger cohorts. Falls are the primary reason for mandibular fracture in the elderly with 30% of individuals over 65 years of age falling each year. This increases to more than 40% in persons 80 years and older. Elderly persons with atrophic mandible have less osteogenic capability and reduced blood flow, and may have a complex medical history, so that management of a fracture of the mandible may require special considerations. The purpose of this review paper was to examine demographic patterns and the etiology of mandibular fractures in the elderly; and to evaluate treatment strategies.     

Etiology,distribution, treatment modalities and complications of maxillofacial fractures

Purpose: This study evaluated the trends and factors associated with maxillofacial fractures treated from 1997 to 2007 in the Oral and Maxillofacial Surgery Department of the Clermont-Ferrand University Hospital. Material and Methods: This study included 364 patients of which 82% were men and 45%, 20-29-years old. The etiology, anatomical distribution, treatment modality and complications of maxillofacial fractures were examined. Results: Overall, interpersonal violence, traffic accidents and falls were the most common mechanisms of injury. There was a decreasing trend in traffic accidents and increasing one in falls as a cause of fracture over the 11-years period of this study. Young male patients were preferentially victim of interpersonal violence and traffic accidents, while middle-aged ones were of falls and work-related accidents. Middle-aged female patients were preferentially victim of traffic accidents and interpersonal violence, while older ones were of falls. And the number of fractures per patient varied according to the mechanism of injury: low after work-related accidents and high after traffic accidents. About two-third of fractures involved the mandible. Most of these mandibular fractures were treated by osteosynthesis with or without intermaxillary fixation, with the proportion of the latter increasing over time. There were very few postoperative infections and only in mandible. Conclusions: Maxillofacial fractures predominantly occur in young men, due to interpersonal violence. There is nevertheless an increasing trend in falls as a cause of fracture, especially in female patients, consistent with the increasing trend in presentation of older people. Most maxillofacial fractures involve the mandible and there is an increasing trend in treating these fractures by osteosynthesis without intermaxillary fixation. Antibiotic prophylaxis associated with dental hygiene care can be indicated to prevent postoperative infections. Key words:Maxillofacial fractures, Epidemiology, Trends, Influencing factors, Fall, Age, Gender, Antibiotic prophylaxis.     

口腔颌面部骨折88例临床分析

目的:总结分析我科2006年以来3.5年中口腔颌面部骨折诊治体会。方法:对88例口腔颌面部骨折住院病例进行回顾性临床分析,包括年龄、性别、致伤原因、损伤部位、类型、治疗方式等。结果:下颌骨骨折72例(82%),上颌骨骨折10例(11%),颧骨骨折6例(7%)。交通事故伤38例(44%),其中机动车致伤26例(30%),非机动车致伤12例(14%);他伤18例(占20%);意外伤32例(36%)。本组病例中10例单纯采用非手术钛牵引钉颌间牵引方法治疗,54例采用手术切开复位钛板钛钉内固定治疗,余24例为钛钉颌间牵引下切开复位内固定。结论:颌面部骨折多因交通事故所致,且多发于下颌骨。钛钉颌间牵引内固定术是一种良好的治疗颌骨骨折的方法。     

Haemorrhage control beyond Advanced Trauma Life Support (ATLS) protocol in life threatening maxillofacial trauma – experience from a level Ⅰ trauma centre

Maxillofacial injuries are usually not life-threatening and do not get priority over other associated injuries. However, some maxillofacial injuries with active oral or nasal bleeding need immediate management due to threatened airway and blood loss. In the case of major active vascular bleeding, measures such as local pressure, anterior nasal packing, posterior nasal packing, and balloon tamponade are ineffective. In these cases, angiography and transcatheter arterial embolisation (TAE) are used to treat life-threatening haemorrhage caused by maxillofacial trauma. We analysed the medical records of 39 patients with severe maxillofacial trauma and life-threatening haemorrhage that was a result of intractable oral or nasal bleeding. These patients were considered for TAE from January 2010 to December 2019. A total of 1668 patients was admitted, out of which 39 (2.3%) had severe maxillofacial injuries with life-threatening oral or nasal bleeding and underwent TAE. Out of a total of 39 patients, 38 were male and one female. Ages ranged from 16 to 65 years. Road traffic injury was the most common cause of injury (79.5%), Lefort I and II were the most common facial fractures, and traumatic brain injury was the most common associated injury. Embolisation and bleeding control were done successfully in all 39 patients with no procedure-related complications. A total of 17 deaths during the study period were due to severe traumatic brain injuries or haemorrhagic shock.     

Pattern and treatment of facial trauma in pediatric and adolescent patients

Pediatric maxillofacial trauma is a challenge for surgeons. There are no completely defined protocols, and sometimes, the initial management could be complex. The aim of this research was to perform a retrospective study to analyze the pattern and treatment of maxillofacial fractures in pediatric and adolescent patients. We reviewed the clinical records of 2986 patients treated at the Oral and Maxillofacial Surgery Division of Piracicaba Dental School between 1999 and 2008. Seven hundred fifty-seven patients were younger than 18 years and were divided into 3 groups according to age; the age and sex of the patients, etiology, fractures and associated injury, treatment, and complications were evaluated. Five hundred thirty boys (70.01%) and 227 girls (29.99%) were treated for injuries with major prevalence in adolescents. The most common injury causes were bicycle accidents (29.06%) and falls (28.40%). The mandible was the most fractured bone (44.8%); associated injuries were lacerations of the soft tissue and dental trauma. Surgical treatment was performed in 75 cases (30%) with minor complications (10% of surgical patients). We conclude that maxillofacial trauma in child is associated to fall and bicycle accidents; the mandible is more affected than other maxillofacial structures, and frequently, nonsurgical treatment is performed.     

Analysis of the Pattern of Maxillofacial Fracture by Five Departments in Tokyo: A Review of 674 Cases

We studied maxillofacial fractures treated by departments of oral and maxillofacial surgery in Tokyo. A retrospective review of records and radiographs for patients admitted during the 5-year period from 2000 to 2004 was conducted at five departments in Tokyo. Date, age, gender, cause of injury, fracture site, concomitant injury, domestic violence against women, and treatment were reviewed. 674 patients with maxillofacial fractures were admitted. Male-to-female ratio was 3.6 : 1. The most frequent age group was 21–25 years. Fractures of the mandible were most frequent (87%), followed by the maxilla (14%) and the zygomatic bone (12%). Thirty-one percent of fractures were due to traffic accidents, 29% to accidental falls, 23% to violence and 14% to sports. The incidence of maxillofacial fractures caused by traffic accidents was lower, and that caused by falls and violence were higher than in other countries. Seventeen percent of the maxillofacial fracture patients had concomitant injuries. The incidence of domestic violence-related maxillofacial fracture was 1.6% of all cases. These cases were mainly caused by a husband (55%) or a sexual partner (36%). Most patients (67%) were treated by open reduction surgery. However, condylar fracture alone was usually treated by closed reduction surgery.     

198例老年颌面部骨折患者临床分析

目的 了解老年颌面部骨折患者的临床特征。方法 对2010年7月—2017年10月收治的198例老年颌面部骨折手术患者的临床资料进行回顾,分析创伤原因、骨折部位、合并伤、系统性疾病、治疗方法等临床特征。结果 198例老年颌面部骨折患者,男女比3.95︰1,平均年龄66.15岁;交通事故伤（78例,39.39%）、摔伤（49例,24.75%）、高坠伤（33例,16.67%）是老年人颌面部骨折的主要原因;下颌骨是最常见的骨折部位（120例）;60例患者同时伴发颌面部以外的创伤,四肢损伤最多（28例）;66例患有系统性疾病,最常见的是心血管疾病（50例）。198例患者的治疗方法主要是小型或微型接骨板切开复位坚强内固定。结论 坠跌伤和交通事故伤是老年颌面部骨折的主要原因,应采取有效的预防和干预措施。     

Maxillofacial fractures in Southern Bulgaria - a retrospective study of 1706 cases.

The present retrospective study investigated various types, aetiology, complications and methods of treatment of maxillofacial fractures managed in the Department of Maxillofacial Surgery, Medical University, Plovdiv, Bulgaria. PATIENTS AND METHODS: A total of 1706 patients were studied with 2534 fractures treated between 1994 and 2003. The analysis included data on age and gender of patients, causes and types of fractures (mean number of fractures per patient - 1.48) as well as the treatments used and the associated complications. RESULTS: Most maxillofacial fractures were sustained by 574 men (age range 21-30 years). The ratio of males to females was 4.6:1. Most fractures were caused by violent assault - 1040 (61%), followed by motor vehicle accidents - 264 (15.5%), fall - 213 (12.5%) and bites from animals - 72 (4%). Fractures of the mandible were sustained by 1261 patients (74%), fractures of the maxilla by 97 (6%), fractures of the zygomatic bone by 277 (16%), nasal fractures by 63 (4%) and multiple fractures by 8 (0.5%). In 1330 (77%) patients the fractures were treated by closed reduction; in 264 patients (16%) by open reduction and fixation, and for the remaining 112 patients (7%) were managed with combined closed and open reduction. The mortality rate was 0.2%, the lethal cases being a result of a combination of severe fractures in the maxillofacial region and trauma to other organs/systems. CONCLUSION: The most common cause of traumatic injury in the maxillofacial region in this study sample was assault, predominantly affecting men. The fractures were treated using various methods but mostly by closed reduction plus fixation.